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MICHEL KATIEHANNON, WATTS MAYAHAZARIKA, BRESLIN JESSICA, TOBIN‐TYLER ELIZABETH. Stopping the Vicious Cycle: Equitable Enforcement Strategies to Achieve Safe, Stable, and Accessible Housing for People with Disabilities. Milbank Q 2024; 102:43-63. [PMID: 38219273 PMCID: PMC10938926 DOI: 10.1111/1468-0009.12683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/20/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024] Open
Abstract
Policy Points People with disabilities experience a vicious cycle of poverty, poor health, and marginalization partly because of the inequitable implementation and enforcement of laws, including underenforcement of civil rights and housing laws and overenforcement of punitive nuisance and criminal laws. Inequitable enforcement reflects policy choices that prioritize powerful entities (e.g., landlords, developers) to the detriment of people who experience intersectional structural discrimination based on, for example, race, disability, and income. Equitable enforcement, a process of ensuring compliance with the law while considering and minimizing harms to marginalized people, can promote health and disability justice by increasing access to safe, stable, and accessible housing.
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Rizzi M, Attwell K. Giving Bad Science the Stamp of Approval: Policy and Legal Consequences of a Vaccine Scare in Italy. Public Health Rev 2024; 45:1606756. [PMID: 38419733 PMCID: PMC10899427 DOI: 10.3389/phrs.2024.1606756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Affiliation(s)
- Marco Rizzi
- UWA Law School, University of Western Australia, Perth, WA, Australia
| | - Katie Attwell
- School of Social Sciences, University of Western Australia, Perth, WA, Australia
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Arbel E, Reese A, Oh K, Mishra A. Medical Law and Medical School Curricula: A Systematic Review. Cureus 2024; 16:e54377. [PMID: 38505453 PMCID: PMC10948381 DOI: 10.7759/cureus.54377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/21/2024] Open
Abstract
Health law plays a crucial role in the field of medicine, as it dictates appropriate practices, regulations, and rights and responsibilities for healthcare professionals and patients. Despite this undeniable relationship, there is a lack of focus on health law, and an outdated hidden curriculum in medical education has perpetuated long-standing negative perceptions of the legal system. PubMed was searched for articles related to medicolegal education that were published from January 1950 to December 2022. The following search terms were utilized: "(medical student) AND (law OR legal OR medico-legal) AND (education)". Literature that directly or indirectly discussed the relationship between law and medicine as well as the role of medical student education within the medicolegal nexus were reviewed. Additional literature was identified from reference lists of systematic and literature reviews. The authors manually reviewed each included publication to determine key details, study populations, and conclusions. The PubMed search revealed 3,592 papers that were sorted for relevance. Forty-four articles published between 1971 and 2022 were reviewed and analyzed. Three main themes consistently emerged from the discussions in these articles. The first theme concerns the sentiment among medical students that they were ill-prepared to manage the legal aspects of healthcare. The second theme concerns the negative perception of health law by medical students. The third theme details the benefits of including medicolegal courses in medical school curricula. This study sheds light on the notion that medical students feel ill-prepared to handle the legal aspects of healthcare due to limited medicolegal education. Furthermore, negative perceptions of the legal field continue to exist amongst medical students due to a plethora of factors, including an outdated hidden curriculum. Incorporating medicolegal courses into medical school curricula can foster positive attitudes toward the field of law and lead to enhanced professional ethics, increased patient advocacy, and potentially improved patient outcomes.
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Affiliation(s)
- Eylon Arbel
- School of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Alyssa Reese
- School of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Kenny Oh
- Department of Surgery, Lewis Katz School of Medicine, Philadelphia, USA
| | - Archana Mishra
- Internal Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
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Archer M, Willmott L, Chambaere K, Deliens L, White BP. What Domains of Belgian Euthanasia Practice are Governed and by Which Sources of Regulation: A Scoping Review. Omega (Westport) 2023:302228231221839. [PMID: 38095044 DOI: 10.1177/00302228231221839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Multiple sources of regulation seek to shape euthanasia practice in Belgium, including legislation and training. This study comprehensively mapped which of these sources govern which domains of euthanasia practice, such health professionals' obligations, or managing patient requests. METHOD Scoping review methodology was used to search for scholarly records which discussed Belgian euthanasia regulation. Template analysis was used to generate themes describing the domains of euthanasia practice governed by sources of regulation. RESULTS Of 1364 records screened, 107 records were included. Multiple sources of regulation govern each domain, which are: the permissible scope of euthanasia; the legal status of a euthanasia death; the euthanasia process; the rights, obligations, and roles of those involved; system workings; and support for health professionals who provide euthanasia. CONCLUSIONS Domains with significant yet fragmented regulation may lead to inconsistent care provision. Policymakers should develop coherent guidance to support health professionals to navigate this regulatory landscape.
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Affiliation(s)
- Madeleine Archer
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
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Donckels EA, Cunniff L, Regenold N, Esselman K, Muther E, Bhatti A, Eiden AL. Understanding Diversity of Policies, Functionalities, and Operationalization of Immunization Information Systems and Their Impact: A Targeted Review of the Literature. Vaccines (Basel) 2023; 11:1242. [PMID: 37515057 PMCID: PMC10385437 DOI: 10.3390/vaccines11071242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic has focused attention on the use of immunization information systems (IIS) to record and consolidate immunization records from a variety of sources to generate comprehensive patient immunization histories. Operationalization of IIS in the United States is decentralized, and as such, there are over 60 different IIS with wide variations in enabling policies and functionalities. As such, the policies that inform the development and operation of those sub-national IIS exist at the state and sometimes city levels. A targeted literature review was conducted to identify IIS policies and functionalities and assess their impact. The authors identified articles published from 2012 to 2022 that discussed or evaluated IIS policies and functionalities and screened titles, abstracts, and full text for inclusion. When selected for inclusion, authors extracted IIS policy/functionality characteristics and qualitative or quantitative outcomes of their implementation, where applicable. The search terms yielded 86 articles, of which 39 were included in the analysis. The articles were heterogeneous with respect to study design, interventions, outcomes, and effect measures. Out of the 17 IIS policies and functional components identified in the targeted literature review, the most commonly evaluated were provider-based patient reminder/recall, IIS-based centralized reminder/recall, and clinical decision support. Patient reminder/recall had the most published research and was associated with increased vaccination rates and vaccine knowledge. Despite the lack of quantitative evidence, there is a consensus that immunization data interoperability is critical to supporting IIS data quality, access, and exchange. Significant evidence gaps remain about the effectiveness of IIS functionalities and policies. Future research should evaluate the impact of policies and functionalities to guide improved utilization of IIS, increase national interoperability and standardization, and ultimately improve vaccination coverage and population health.
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Affiliation(s)
| | | | - Nina Regenold
- Real Chemistry Market Access, San Francisco, CA 94108, USA
| | | | - Erik Muther
- Real Chemistry Market Access, San Francisco, CA 94108, USA
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Shah SK, Perez-Cardona L, Helner K, Massey SH, Premkumar A, Edwards R, Norton ES, Rogers CE, Miller ES, Smyser CD, Davis MM, Wakschlag LS. How penalizing substance use in pregnancy affects treatment and research: a qualitative examination of researchers' perspectives. J Law Biosci 2023; 10:lsad019. [PMID: 37435609 PMCID: PMC10332932 DOI: 10.1093/jlb/lsad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023]
Abstract
Introduction Laws regulating substance use in pregnancy are changing and may have unintended consequences on scientific efforts to address the opioid epidemic. Yet, how these laws affect care and research is poorly understood. Methods We conducted semi-structured qualitative interviews using purposive and snowball sampling of researchers who have engaged pregnant people experiencing substance use. We explored views on laws governing substance use in pregnancy and legal reform possibilities. Interviews were double coded. Data were examined using thematic analysis. Results We interviewed 22 researchers (response rate: 71 per cent) and identified four themes: (i) harms of punitive laws, (ii) negative legal impacts on research, (iii) proposals for legal reform, and (iv) activism over time. Discussion Researchers view laws penalizing substance use during pregnancy as failing to treat addiction as a disease and harming pregnant people and families. Respondents routinely made scientific compromises to protect participants. While some have successfully advocated for legal reform, ongoing advocacy is needed. Conclusion Adverse impacts from criminalizing substance use during pregnancy extend to research on this common and stigmatized problem. Rather than penalizing substance use in pregnancy, laws should approach addiction as a medical issue and support scientific efforts to improve outcomes for affected families.
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Affiliation(s)
| | - Leishla Perez-Cardona
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Khrystyna Helner
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Suena H Massey
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashish Premkumar
- Department of Obstetrics & Gynecology, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Renee Edwards
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Elizabeth S Norton
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Christopher D Smyser
- Departments of Neurology, Pediatrics, and Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Matthew M Davis
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Lauren S Wakschlag
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
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McPhail M, Zhang H, Bhimani Z, Bubela T. Lessons from Canada's notice of compliance with conditions policy for the life-cycle regulation of drugs. J Law Biosci 2023; 10:lsad008. [PMID: 37064046 PMCID: PMC10101551 DOI: 10.1093/jlb/lsad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 06/19/2023]
Abstract
Innovative health technologies are not well regulated under current pathways, leading regulators to adopt contextual, life-cycle regulatory models, which authorize drugs based on earlier clinical evidence subject to the conduct of post-market trials that confirm clinical benefit and safety. In this paper, we evaluate all drugs authorized in Canada under the Notice of Compliance with conditions (NOC/c) policy from 1998 to 2021 to analyze its function, identify challenges and areas for improvement, and make recommendations to inform Health Canada's regulatory reforms. We analyzed a sample of 148 drugs authorized between 1998 and 2021, including characteristics about the pre- and post-market clinical trials, finding that most NOC/c authorizations are based on one, single-arm clinical trial using a surrogate endpoint. Post-market trials are more likely to be randomized, Phase III trials but mostly use surrogate endpoints. Based on our findings, we recommend increasing decision-making transparency throughout the regulatory process, developing comprehensive eligibility criteria for selecting appropriate health technologies, modernizing pre-market evidence requirements, adopting a more active role in designing post-market trials, and utilizing automatic expiry, stronger penalties, and ongoing disclosure of the status of post-market trials to promote compliance.
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Affiliation(s)
| | - Howard Zhang
- Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada
| | - Zohra Bhimani
- Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada
| | - Tania Bubela
- Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada
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Holčapek T, Šolc M, Šustek P. Telemedicine and the standard of care: a call for a new approach? Front Public Health 2023; 11:1184971. [PMID: 37213629 PMCID: PMC10192621 DOI: 10.3389/fpubh.2023.1184971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
Telemedicine, understood as the provision of health care by a health professional to a patient who is physically not in the same location as the health professional, has many actual and potential benefits. It also has some disadvantages though, including a higher risk of misdiagnosis or another unfavorable outcome of certain remotely-provided services. In principle, the regime of legal liability for medical malpractice is the same for telemedicine as for traditional physical care. The general outline of the standard of care, which includes respect for medical science, the patient's individuality and objective possibilities, is abstract and flexible enough to be used for remote care without the need for redefinition. The quality of health care should be evaluated on the basis of the whole scale of risks and benefits it brings to a particular patient, including accessibility and comfort. In general, it should be permissible to provide a medical service remotely on the condition that its overall quality is at least as good as its comparable physical alternative. In other words, certain decrease in quality of some aspects of remote care can be compensated by other advantages. In terms of public health, support for telemedicine may bring a great improvement in the access to health care, and thus help significantly the individual members of the population. From the individual perspective, respect for personal autonomy implies that a patient should have every right to opt for a remote service, provided that there exists a true choice between meaningful options which is made on the basis of full information. If telemedicine is to fulfill its potential without sacrificing the protection of patients and their rights, reasonable guidelines for remote services need to be defined for particular medical fields, and for specific procedures within them. Among other issues, these guidelines must address the question of when it is necessary to refer the patient to physical care.
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Affiliation(s)
- Tomáš Holčapek
- Department of Medical Law, Faculty of Law, Charles University, Prague, Czechia
- Department of Civil Law, Faculty of Law, Charles University, Prague, Czechia
- *Correspondence: Tomáš Holčapek
| | - Martin Šolc
- Department of Medical Law, Faculty of Law, Charles University, Prague, Czechia
- Department of Civil Law, Faculty of Law, Charles University, Prague, Czechia
| | - Petr Šustek
- Department of Medical Law, Faculty of Law, Charles University, Prague, Czechia
- Department of Civil Law, Faculty of Law, Charles University, Prague, Czechia
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Dent C. Autonomy Versus Integrity: The "Mind" and its "Body" in the Law. J Law Med 2022; 29:1241-1254. [PMID: 36763029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The law has changed, over the past century, in respect of how it sees the legal subject. From the 1980s, the law began to articulate an understanding of the "mind" of those who came before the courts. This is evident in decisions around nervous shock in negligence law. The law also began to articulate a distinction between the "mind" and the "body" - evident in the law of consent to health treatment. The engagement of the courts with the development of the capacity of children to consent, in particular, when tied with the idea of "abstraction", allows for an in-depth exploration of the concepts. The assessment of the law in the two areas, in turn, facilitates an exploration of the law's understanding of the "autonomy" and the bodily "integrity" of the legal subject.
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Affiliation(s)
- Chris Dent
- Professor of Law, College of Arts, Business, Law and the Social Sciences, School of Law, Murdoch University
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McMichael BJ, Markowitz S. Toward a Uniform Classification of Nurse Practitioner Scope of Practice Laws. Med Care Res Rev 2022:10775587221126777. [PMID: 36172783 DOI: 10.1177/10775587221126777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many states' scope of practice laws limits the ability of nurse practitioners to deliver care by requiring physician supervision of their practices and prescribing activities. A robust literature has evolved around examining the role of these scope of practice laws in various contexts, including labor market outcomes, health care access, health care prices, and the delivery of care for specific diseases. Unfortunately, these studies use different, and sometimes conflicting, measures of scope of practice laws, limiting their comparability and overall usefulness to policymakers and future researchers. We address this salient problem by providing a recommended coding of nurse practitioner scope of practice laws over a 24-year period based on actual statutory and regulatory language. Our classification of scope of practice laws solves an important problem within this growing literature and provides a solid legal foundation for researchers as they continue to investigate the effects of these laws.
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de Andrade NRN, Nunes CFO, Albuquerque FB, Araújo CEL, Ferreira AF, dos Reis ADS, Ramos AN. Limits and possibilities for the development of public health research in the legal system. Rev Saude Publica 2022; 56:76. [PMID: 36043654 PMCID: PMC9388063 DOI: 10.11606/s1518-8787.2022056004203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/31/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To characterize databases of the courts of justice of Brazil as a potential tool for research in Collective Health, in its interface with the legal sciences. METHODS Cross-sectional study of quantitative and descriptive nature, focusing on analysis of strategic management and judicial systems. RESULTS Databases used by the Common Justice in the Federation Units to systematize judicial processes were identified and analyzed. A total of 123 databases were found in the courts of justice per state, with emphasis on the South and Northeast regions, in contrast to the North region, which has a smaller number of systems. This large number of judicial systems limits access to legal operators, and hinders the collection of evidence by health researchers and, consequently, impacts the strategic management of the Executive Branch. There were limitations from design to transparent and democratic data extraction by the users themselves, as well as restricted integration between bases. CONCLUSIONS Although advances have been made in recent years by the courts of justice to unify these databases, the multiplicity of information systems used in the Common State Justice complicates the management of knowledge, limits the development of research, even when carried out by lawyers or researchers in the legal area, as well as generates slow data extraction for public management. It is recognized the need for additional efforts for standardization, as well as for improvement of these databases, expanding access, transparency and integration with a view to a transdisciplinary look between the field of Law and Collective Health.
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Affiliation(s)
- Nayla Rochele Nogueira de Andrade
- Universidade Federal do CearáFaculdade de MedicinaPrograma de Pós-Graduação em Saúde PúblicaFortalezaCEBrasil Universidade Federal do Ceará. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Fortaleza, CE, Brasil
| | - Carlos Francisco Oliveira Nunes
- Universidade Federal de Santa CatarinaPrograma de Pós-Graduação em Engenharia e Gestão do ConhecimentoFlorianópolisSanta CatarinaBrasil Universidade Federal de Santa Catarina. Programa de Pós-Graduação em Engenharia e Gestão do Conhecimento. Florianópolis, Santa Catarina, Brasil
| | - Felipe Braga Albuquerque
- Universidade Federal do CearáFaculdade de DireitoDepartamento de Direito PúblicoFortalezaCEBrasil Universidade Federal do Ceará. Faculdade de Direito. Departamento de Direito Público. Fortaleza, CE, Brasil
- Universidade Federal do CearáFaculdade de DireitoPrograma de Pós-Graduação em DireitoFortalezaCEBrasil Universidade Federal do Ceará. Faculdade de Direito. Programa de Pós-Graduação em Direito. Fortaleza, CE, Brasil
| | - Carmem E. Leitão Araújo
- Universidade Federal do CearáFaculdade de MedicinaPrograma de Pós-Graduação em Saúde PúblicaFortalezaCEBrasil Universidade Federal do Ceará. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Fortaleza, CE, Brasil
- Universidade Federal do CearáFaculdade de MedicinaDepartamento de Saúde ComunitáriaFortalezaCEBrasil Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Comunitária. Fortaleza, CE, Brasil
| | - Anderson Fuentes Ferreira
- Universidade Federal do CearáFaculdade de MedicinaPrograma de Pós-Graduação em Saúde PúblicaFortalezaCEBrasil Universidade Federal do Ceará. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Fortaleza, CE, Brasil
| | - Adriana da Silva dos Reis
- NHR BrasilFortalezaCEBrasil Netherlands Hanseniasis Relief Brasil - NHR Brasil. Fortaleza, CE, Brasil
| | - Alberto Novaes Ramos
- Universidade Federal do CearáFaculdade de MedicinaPrograma de Pós-Graduação em Saúde PúblicaFortalezaCEBrasil Universidade Federal do Ceará. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Fortaleza, CE, Brasil
- Universidade Federal do CearáFaculdade de MedicinaDepartamento de Saúde ComunitáriaFortalezaCEBrasil Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Comunitária. Fortaleza, CE, Brasil
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Dourado DDA, Aith FMA. The regulation of artificial intelligence for health in Brazil begins with the General Personal Data Protection Law. Rev Saude Publica 2022; 56:80. [PMID: 36043658 PMCID: PMC9423092 DOI: 10.11606/s1518-8787.2022056004461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/04/2022] [Indexed: 11/05/2022] Open
Abstract
Artificial intelligence develops rapidly and health is one of the areas where new technologies in this field are most promising. The use of artificial intelligence can modify the way health care and self-care are provided, besides influencing the organization of health systems. Therefore, the regulation of artificial intelligence in healthcare is an emerging and essential topic. Specific laws and regulations are being developed around the world. In Brazil, the starting point of this regulation is the Lei Geral de Proteção de Dados Pessoais (LGPD - General Personal Data Protection Law), which recognizes the right to explanation and review of automated decisions. Discussing the scope of this right is needed, considering the necessary instrumentalization of transparency in the use of artificial intelligence for health and the currently existing limits, such as the black-box system inherent to algorithms and the trade-off between explainability and accuracy of automated systems.
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Affiliation(s)
- Daniel de Araujo Dourado
- Universidade de São PauloCentro de Pesquisa em Direito SanitárioSão PauloSPBrasil Universidade de São Paulo. Centro de Pesquisa em Direito Sanitário. São Paulo, SP, Brasil,Universidade de São PauloFaculdade de MedicinaPrograma de Pós-Graduação em Saúde ColetivaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Coletiva. São Paulo, SP, Brasil
| | - Fernando Mussa Abujamra Aith
- Universidade de São PauloCentro de Pesquisa em Direito SanitárioSão PauloSPBrasil Universidade de São Paulo. Centro de Pesquisa em Direito Sanitário. São Paulo, SP, Brasil,Universidade de São PauloFaculdade de MedicinaPrograma de Pós-Graduação em Saúde ColetivaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Coletiva. São Paulo, SP, Brasil,Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de PolíticaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Política, Gestão e Saúde. São Paulo, SP, Brasil
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Willmott L, Feeney R, Del Villar K, Chambaere K, Yates P, Mitchell G, White B. Assisted Deaths Prior to the Voluntary Assisted Dying Act 2017 (Vic): Would Patients Have Met the Eligibility Criteria to Request Voluntary Assisted Dying? J Law Med 2022; 29:811-828. [PMID: 36056667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Unlawful assisted dying practices have been reported in Australia for decades. Voluntary assisted dying (VAD) is now lawful in Victoria and Western Australia in limited circumstances and will soon be lawful in a further four Australian States. This article examines nine cases involving unlawful assisted dying practices in Victoria in the 12 months prior to the commencement of the Voluntary Assisted Dying Act 2017 (Vic) in 2019. It explores whether, if that Act had been in operation at the relevant time, these patients would have been eligible to request VAD, having regard to their decision-making capacity and their disease, illness or medical condition. Many of these patients would not have been eligible to request VAD had the legislation been operational, primarily because they lacked decision-making capacity. As VAD is lawful only in a narrow set of circumstances, unlawful assisted deaths may continue to occur in those States where voluntary assisted dying is legal.
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Affiliation(s)
- Lindy Willmott
- Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology
| | - Rachel Feeney
- Postdoctoral Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology
| | - Katrine Del Villar
- Postdoctoral Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology
| | - Kenneth Chambaere
- Professor Public Health, Sociology & Ethics of the End of Life, End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Ghent University
| | - Patsy Yates
- Distinguished Professor, Faculty of Health, Queensland University of Technology
| | - Geoffrey Mitchell
- Emeritus Professor, Primary Care Clinical Unit, University of Queensland
| | - Ben White
- Professor of End-of-Life Law and Regulation, Australian Centre for Health Law Research, Queensland University of Technology
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14
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White BP, Del Villar K, Willmott L, Close E, Jeanneret R. Mapping the Legal Regulation of Voluntary Assisted Dying in Victoria: The Coherence of a New Practice within the Wider Legal System. J Law Med 2022; 29:783-810. [PMID: 36056666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article undertakes the first comprehensive mapping exercise of the legal regulation of voluntary assisted dying (VAD) in Victoria. Despite the detailed nature of the Voluntary Assisted Dying Act 2017 (Vic), this analysis reveals that VAD is also regulated by a diverse array of other law: a further 20 pieces of legislation and 27 broad areas of law. In some instances, this legal regulation beyond the principal VAD legislation is significant for how the VAD system operates in practice. The article then identifies the implications of this mapping exercise for the coherence of the law, focusing in particular on the domains of consistency, comprehensiveness, and completeness. Findings include identifying areas of significant incoherence and the implications of this for law reformers, policymakers, and users of the law, including patients, families, health practitioners, and health service providers.
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Affiliation(s)
- Ben P White
- Professor of End-of-Life Law and Regulation, Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology
| | - Katrine Del Villar
- Postdoctoral Research Fellow, Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology
| | - Lindy Willmott
- Professor, Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology
| | - Eliana Close
- Postdoctoral Research Fellow, Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology
| | - Ruthie Jeanneret
- PhD Candidate, Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology
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15
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Simon DA, Shachar C, Cohen IG. Skating the line between general wellness products and regulated devices: strategies and implications. J Law Biosci 2022; 9:lsac015. [PMID: 35855400 PMCID: PMC9280986 DOI: 10.1093/jlb/lsac015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/04/2022] [Indexed: 05/21/2023]
Abstract
Health technology is advancing at a rapid clip, with many of these technologies appearing on consumer products like smartphones and tablets. Federal regulators have responded to these changes with a flexible approach that allows firms to manufacture a 'general wellness product' ('GWP') without being subject to regulation typically applied to 'devices' that diagnose or treat a disease or condition. Using currently available medical products and devices from across a spectrum of diseases, we describe how firms can use this existing regulatory framework to develop innovative products by 'skating the line' between mostly unregulated GWPs and regulated devices. On the one hand, we find that skating the line offers a variety of benefits, including potential improvements to product development, innovation, and patient access to medical technologies. On the other hand, we show that this technique has potential costs to patient safety, competition, and data sharing. Skating the regulatory line between GWP and devices, in other words, offers important benefits but is not without risks. Any further regulatory action to address such risks should be careful to leave significant unregulated space for product development.
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16
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Maeng D, Li Y, Lawrence M, Keane S, Cross W, Conner KR, Lee HB. Impact of mandatory COVID-19 shelter-in-place order on controlled substance use among rural versus urban communities in the United States. J Rural Health 2022; 39:21-29. [PMID: 35710976 PMCID: PMC9349882 DOI: 10.1111/jrh.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Mandatory COVID-19 shelter-in-place (SIP) orders have been imposed to fight the pandemic. They may also have led to unintended consequences of increased use of controlled substances especially among rural communities due to increased social isolation. Using the data from the American Association of Poison Control Centers, this study tests the hypothesis that the poison control centers received higher rates of calls related to exposures to controlled substances from rural counties than they did from urban counties during the SIP period. METHODS Call counts received by the poison control centers between October 19, 2019 and July 6, 2020 due to exposure to controlled substance (methamphetamine, opioids, cocaine, benzodiazepines, and other narcotics) were aggregated to per-county-per-month-per-10,000 population exposure rates. A falsification test was conducted to reduce the possibility of spurious correlations. FINDINGS During the study period, 2,649 counties in the United States had mandatory SIP orders. The rate of calls reporting exposure to any of the aforementioned controlled substances among the rural counties was higher (14%; P = .047) relative to the urban counties. This overall increase was due to increases in the rates of calls reporting exposure to opioids (26%; P = .017) and methamphetamine (39%; P = .077). Moreover, the rate of calls reporting exposures at home was also higher among the rural counties (14%; P = .069). CONCLUSION The mandatory SIP orders may have had an unintended consequence of exacerbating the use of controlled substances at home in rural communities relative to urban communities.
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Affiliation(s)
- Daniel Maeng
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Yue Li
- Division of Health Policy and Outcomes ResearchDepartment of Public Health SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Michele Lawrence
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sinead Keane
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wendi Cross
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Kenneth R. Conner
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Hochang B. Lee
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
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17
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Shirley LM. Dismantling Obstacles to Gender Affirmation: Reimagining Consent to Medical Treatment by Transgender, Gender Diverse and Non-binary Minors. J Law Med 2022; 29:545-559. [PMID: 35819391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Gender-affirming treatment is currently inaccessible for many transgender, gender diverse and non-binary minors in Australia, with significant implications for these minors' physical and mental wellbeing. Existing legal frameworks create obstacles to treatment by requiring that minors either be supported by their guardians or be able to apply to court, as well as having access to medical and psychological experts. Such requirements do not consider the lived realities, and disproportionate vulnerabilities, experienced by these minors. This article argues that legislative intervention is needed to create a mechanism that renders these treatments more accessible. This argument is supported by findings from recent psychological and statistical studies and is further illustrated by facts from the recent case of Re Imogen.
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18
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Abstract
The practice of nonconsensual intimate exams performed on unconscious patients by medical students during their training has received significant attention in the last several years. Clinicians, medical students, bioethicists, lawyers, and the public have called for explicit and specific consent to take place before all educational intimate examinations of unconscious patients. In response, since January of 2019, dozens of bills have been proposed in more than twenty states, and thirteen of these have been signed into law (in addition to six that passed before 2019). Here, we consider the content of these enacted bills, drawing attention to five variable features and offering these five corresponding legislative recommendations, in hopes of narrowing in on the appropriate ethical scope of consent laws surrounding educational intimate exams: (1) use gender-neutral language; (2) include all intimate exams, not solely pelvic exams; (3) focus on unconscious patients; (4) focus on educational exams; and (5) regulate systems, not individuals.
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19
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Adler L, Zacay G, Schonmann Y, Azuri J, Yehoshua I, Vinker S, Shani M, Heymann AD, Hoffman R. Primary care physicians' attitudes and knowledge regarding medical cannabis and willingness to prescribe it: the Israeli experience. Fam Pract 2022; 39:59-64. [PMID: 34476478 DOI: 10.1093/fampra/cmab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Use of medical cannabis (MC) in Israel has increased since its regulatory approval in 2016. Currently, more than 1% of Israeli adults are treated with MC; this requires primary care physicians (PCPs) to be familiar with this treatment option. OBJECTIVES We assessed the attitudes and knowledge of Israeli PCPs toward MC and evaluated their willingness to prescribe it for different medical conditions. METHODS A cross-sectional survey which was distributed to PCPs in Israel. Physicians were asked about their opinions, knowledge, and willingness to prescribe MC. RESULTS Two hundred and one PCPs answered the questionnaire. Their average age was 47 years (±11.2), 71% were specialists. 51% of the respondents thought that MC is an effective treatment. 63% replied that they had little knowledge and 75% indicated that they would like to deepen it. 61% of the respondents were willing to initiate an MC treatment for a dying patient, while less than 50% were willing to initiate MC treatment for various other conditions. Most respondents indicated that they were willing to renew a prescription for any approved medical condition. Willingness to prescribe MC increased for physicians who agreed that MC was effective (odds ratio [OR] 21.9, 95% confidence interval [CI] 2.40-200.85), for physicians who strongly agreed with the statement that they had sufficient knowledge (OR 5.0, 95% CI 1.58-15.83) and for residents compared with specialists (OR 4.0, 95% CI 1.52-10.73). CONCLUSIONS Our survey revealed PCPs' differing opinions and insufficient knowledge regarding treatment with MC. These findings suggest that continuing medical education regarding MC is needed.
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Affiliation(s)
- Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Galia Zacay
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Joseph Azuri
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Ilan Yehoshua
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Leumit Health Services, Headquarters, Medical Division, Tel Aviv, Israel
| | - Michal Shani
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine Central District, Clalit Health Services, Rehovot, Israel
| | - Anthony D Heymann
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - Robert Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
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20
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Shi J, Guo Y, Cavagnaro MJ, Cai J, Liu Z. Speech After Long Silence-An Appraisee-Based Comprehensive Analysis With Retrospective and Future Perspectives on Current ID Policy of Transpersons in China. Front Public Health 2021; 9:793162. [PMID: 34917584 PMCID: PMC8669387 DOI: 10.3389/fpubh.2021.793162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/08/2021] [Indexed: 12/04/2022] Open
Abstract
As the sexual minority in China, transpersons remain faced with various realistic challenges. In recent years, however, there has been a significant progress made in the protection given to the rights that transpersons deserve. Currently, the citizens who have changed their gender through sex reassignment surgery can make applications to the local police station for changing their gender registration and get issued a new ID card. This is regarded as a crucial milestone in reducing the bias against transpersons and protecting their legitimate rights in China. Highlighted by the case of an extraordinary appraisee who have received SRS to change from male to female and started a new life with a new ID, not only does this article construe the current ID policy and the detailed process of ID card change for transpersons in China, it also reveals the living and developmental conditions facing transpersons in China. Finally, the visibility of the community of transpersons is improved to eradicate the discrimination against transpersons.
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Affiliation(s)
- Jian Shi
- Department of Hematology and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yadong Guo
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | | | - Jifeng Cai
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Zhuoying Liu
- Health Law Research Center, School of Law, Central South University, Changsha, China
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21
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Hawkins C, Rothwell C, Close H, Emmett C, Hesselgreaves H. Legal Issues in Life-Limiting Illness: Can Cross-Agency, Interprofessional Education Support Integration of Care? J Law Med 2021; 28:1082-1091. [PMID: 34907687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Legal issues are prevalent in life-limiting illness, relating to social welfare needs as well as delivery of legally compliant care. Yet the broad range of agencies delivering care is fragmented, risking unmet needs. This mixed-methods research explored the potential of cross-agency, interprofessional education to raise awareness and understanding of legal needs in this context and promote closer service integration. Four identical workshops, run in north-east England, brought together 99 participants from health, social, legal, advice, charitable, public and private sectors. Participants were overwhelmingly positive about the value of learning together with 97% wanting more sessions. Learning priorities included greater awareness of services and referral routes as well as areas of law relating to advance care planning and mental capacity. Interprofessional education, spanning the breadth of relevant agencies and supported by national strategy, was identified as a route to integrating services.
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Affiliation(s)
- Colette Hawkins
- Academic Consultant in Palliative Medicine, St Oswald's Hospice; Honorary Clinical Lecturer, Newcastle University
| | - Charlotte Rothwell
- Senior Research Associate, Department of Medical Education, Newcastle University
| | - Helen Close
- Senior Research Methodologist, Population Health Sciences Institute, Newcastle University
| | - Charlotte Emmett
- Associate Professor, Northumbria Law School, Northumbria University
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22
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Boggio A, Yotova R. Gene editing of human embryos is not contrary to human rights law: A reply to Drabiak. Bioethics 2021; 35:956-963. [PMID: 34453362 DOI: 10.1111/bioe.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 04/12/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
In an article in this journal, Katherine Drabiak argues that green lighting genome editing of human embryos is contrary to "fundamental human rights law." According to the author, genome editing of human embryos violates what we should recognize as a fundamental human right to inherit a genome without deliberate manipulation. In this reply article, we assess Drabiak's legal analysis and show methodological and substantive flaws. Methodologically, her analysis omits the key international legal instruments that form the so-called International Bill of Rights and thus fails to provide a full and accurate account of the fundamental international human rights standards. Substantively, Drabiak invokes, as a basis for prohibiting gene editing of human embryos, a legal standard (the rights and integrity of the future child) that is unknown to international law. Contrary to Drabiak's account, genome editing of human embryos is not prohibited under international law. Indeed, the right to health and the right to benefit from scientific progress may be interpreted as the basis of a legal duty to provide equality of access to germline gene editing, once determined it is beneficial and safe to use.
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Affiliation(s)
- Andrea Boggio
- Department of History and Social Sciences, Bryant University, Smithfield, Rhode Island, USA
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23
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Ne'eman A, Stein MA, Berger ZD, Dorfman D. The Treatment of Disability under Crisis Standards of Care: An Empirical and Normative Analysis of Change over Time during COVID-19. J Health Polit Policy Law 2021; 46:831-860. [PMID: 33769474 PMCID: PMC8957387 DOI: 10.1215/03616878-9156005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CONTEXT COVID-19 has prompted debates between bioethicists and disability activists about Crisis Standards of Care plans (CSCs), triage protocols determining the allocation of scarce lifesaving care. METHODS We examine CSCs in 35 states and code how they approach disability, comparing states that have revised their plans over time to those that have not. We offer ethical and legal analyses evaluating to what extent changes to state policy aligned with disability rights law and ethics during the early pandemic and subsequently as stakeholder engagement grew. FINDINGS While disability rights views were not well represented in CSCs that were not updated or updated early in the pandemic, states that revised their plans later in the pandemic were more aligned with advocate priorities. However, many CSCs continue to include concerning provisions, especially the reliance on long-term survival, which implicates considerations of both disability rights and racial justice. CONCLUSIONS The disability rights movement's successes in influencing state triage policy should inform future CSCs and set the stage for further work on how stakeholders influence bioethics policy debates. We offer thoughts for examining bioethics policy making reflecting the processes by which activists seek policy change and the tension policy makers face between expert delegation and mediating values conflicts.
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24
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Beall RF, Hollis A, Kesselheim AS, Spackman E. Reimagining Pharmaceutical Market Exclusivities: Should the Duration of Guaranteed Monopoly Periods Be Value Based? Value Health 2021; 24:1328-1334. [PMID: 34452713 DOI: 10.1016/j.jval.2021.04.1277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To describe the main features of a pharmaceutical market in which the duration of guaranteed monopoly periods would correspond to a new pharmaceutical product's value. METHODS After reviewing patent and regulatory exclusivity-based mechanisms for protecting prescription drug markets from competition to incentivize drug innovation in developed countries, we model market protection mechanisms within the current framework to give the longest-lasting market protections to drug developers that bring the most affordable products to market with highest public health and clinical value. RESULTS An approach tying pharmaceutical market exclusivity to value would have 3 main features. First, it would be based on regulatory exclusivity (ie, the drug regulator refrains from authorizing generic entry for a certain amount of time), rather than patents. Second, the duration of exclusivity period would be pegged to the magnitude of a product's anticipated health impact and its proposed price by using modified methods from the field of health technology assessment. Third, the duration of the value-based exclusivity period would be reassessed routinely 3 years after the product's launch to account for its real-world effectiveness. CONCLUSIONS Linking a drug's proposed price to the duration of its regulatory-based exclusivities would both incentivize the development of high impact, low-cost products and motivate drug developers to introduce these products at lower prices.
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Affiliation(s)
- Reed F Beall
- Department of Community Health Sciences, Cummings School of Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Program on Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Aidan Hollis
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eldon Spackman
- Department of Community Health Sciences, Cummings School of Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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25
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Ó Cathaoir K. The invisible child of personalized medicine. J Law Biosci 2021; 8:lsab029. [PMID: 34512998 PMCID: PMC8421035 DOI: 10.1093/jlb/lsab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/29/2021] [Accepted: 07/13/2021] [Indexed: 06/01/2023]
Abstract
This article seeks to bring the invisible child of personalized medicine out from the shadows through legal analysis and empirical data. It uses Denmark as a case to argue that existing policies, laws and practices on personalized medicine neglect the legal and ethical issues specific to children. The article investigates Danish laws and practices in clinical genetics and describes how the law neglects children's right to self-determination in three ways. Firstly, while child participation is provided for by law, no guidelines have been created to operationalize this norm. Secondly, children's right not to know is inadequately reflected in current policies. Thirdly, the storage of information from prenatal genetic sequencing raises important issues that are in need of reflection. Several recommendations are made, including for strengthening children's participation and limiting parents' access to secondary findings where they relate to untreatable or unpreventable conditions. It furthermore recognizes, however, that children's self-determination in some circumstances should be viewed relationally due to the interconnected nature of genetics.
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26
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Grande D, Luna Marti X, Merchant RM, Asch DA, Dolan A, Sharma M, Cannuscio CC. Consumer Views on Health Applications of Consumer Digital Data and Health Privacy Among US Adults: Qualitative Interview Study. J Med Internet Res 2021; 23:e29395. [PMID: 34106074 PMCID: PMC8262668 DOI: 10.2196/29395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In 2020, the number of internet users surpassed 4.6 billion. Individuals who create and share digital data can leave a trail of information about their habits and preferences that collectively generate a digital footprint. Studies have shown that digital footprints can reveal important information regarding an individual's health status, ranging from diet and exercise to depression. Uses of digital applications have accelerated during the COVID-19 pandemic where public health organizations have utilized technology to reduce the burden of transmission, ultimately leading to policy discussions about digital health privacy. Though US consumers report feeling concerned about the way their personal data is used, they continue to use digital technologies. OBJECTIVE This study aimed to understand the extent to which consumers recognize possible health applications of their digital data and identify their most salient concerns around digital health privacy. METHODS We conducted semistructured interviews with a diverse national sample of US adults from November 2018 to January 2019. Participants were recruited from the Ipsos KnowledgePanel, a nationally representative panel. Participants were asked to reflect on their own use of digital technology, rate various sources of digital information, and consider several hypothetical scenarios with varying sources and health-related applications of personal digital information. RESULTS The final cohort included a diverse national sample of 45 US consumers. Participants were generally unaware what consumer digital data might reveal about their health. They also revealed limited knowledge of current data collection and aggregation practices. When responding to specific scenarios with health-related applications of data, they had difficulty weighing the benefits and harms but expressed a desire for privacy protection. They saw benefits in using digital data to improve health, but wanted limits to health programs' use of consumer digital data. CONCLUSIONS Current privacy restrictions on health-related data are premised on the notion that these data are derived only from medical encounters. Given that an increasing amount of health-related data is derived from digital footprints in consumer settings, our findings suggest the need for greater transparency of data collection and uses, and broader health privacy protections.
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Affiliation(s)
- David Grande
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Xochitl Luna Marti
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Raina M Merchant
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David A Asch
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Abby Dolan
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Meghana Sharma
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, United States
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27
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Treglia M, Pallocci M, Passalacqua P, Giammatteo J, De Luca L, Mauriello S, Cisterna AM, Marsella LT. Medical Liability: Review of a Whole Year of Judgments of the Civil Court of Rome. Int J Environ Res Public Health 2021; 18:6019. [PMID: 34205091 DOI: 10.3390/ijerph18116019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022]
Abstract
Background: Complaints about medical malpractice have increased over time in Italy, as well as other countries around the world. This scenario, perceived by some as a “malpractice crisis”, is a subject of debate in health law and medical law. The costs arising from medical liability lawsuits weigh not only on individual professionals but also on the budgets of healthcare facilities, many of which in Italy are supported by public funds. A full understanding of the phenomenon of medical malpractice appears necessary in order to manage this spreading issue and possibly to reduce the health liability costs. Methods: The retrospective review concerned all the judgments drawn up by the Judges of the Civil Court of Rome, XIII Chamber (competent and specialized section for professional liability trials) published between January 2018 and February 2019. Results: The analysis of data concerning the involved parties showed that in 84.6% of the judgments taken into account, one or more health facilities were sued, while in 58.2% of cases, one or more health workers were present among the defendants. When healthcare providers are the only ones to be summoned, it is dentists and aesthetic doctors/plastic surgeons who undergo most of the claims. In the overall period analyzed, the amount paid was 23,489,254.08 EUR with an average of 163,119.82 EUR. Conclusion: The evidence provided by the reported data is a useful tool to understand medical malpractice in Italy, especially with regard to the occurrence of the phenomenon at a legal level, an aspect still hardly mentioned by existing literature.
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MacDonald NE, Harmon S, Graham JE. Ethics check-up of public health immunization programs in Canada. ACTA ACUST UNITED AC 2021; 47:224-31. [PMID: 34035669 DOI: 10.14745/ccdr.v47i04a09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The World Health Organization (WHO) recognizes immunization as one of the most successful and effective public health interventions for saving lives. In developing a roadmap for prioritizing use of the coronavirus disease 2019 (COVID-19) vaccines in the context of limited supply, WHO highlighted the importance of a values (ethical principles) framework. Immunization does need to be subject to independent ethical scrutiny of vaccine research data, manufacturing practices, the legal and ethical assurance of informed consent, and also social justice issues with respect to program equity, including right to access. An ethics review of Australia's immunization program was reported in 2012. This CANVax (Canadian Vaccination Evidence Resource and Exchange Centre) Brief offers an ethics review of immunization in Canada using the criteria utilized for Australia.
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Conis E, Kuo J. Historical Origins of the Personal Belief Exemption to Vaccination Mandates: The View from California. J Hist Med Allied Sci 2021; 76:167-190. [PMID: 33624793 DOI: 10.1093/jhmas/jrab003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A number of states, starting with California, have recently removed all non-medical exemptions from their laws requiring vaccinations for schoolchildren. California was also one of the earliest states to include a broad non-medical, or personal, belief exemption in its modern immunization law, which it did with a 1961 law mandating polio vaccination for school enrollment, Assembly Bill 1940 (AB 1940). This paper examines the history of AB 1940's exemption clause as a case study for shedding light on the little-examined history of the personal belief exemption to vaccination in the United States. This history shows that secular belief exemptions date back further than scholars have allowed. It demonstrates that such exemptions resulted from political negotiation critical to ensuring compulsory vaccination's political success. It challenges a historiography in which antivaccination groups and their allies led late-nineteenth and early-twentieth century opposition to vaccination mandates while religious groups drove mid-twentieth century opposition. It also complicates the historiographic idea of a return to compulsion in the late 1960s, instead dating this return a decade earlier, to a time when belief exemptions in polio vaccination mandates helped reconcile the goal of a widely vaccinated population with the sacrosanct idea of health as a personal responsibility.
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Dronkers WJ, Amelink QJMA, Buis DR, Broekman MLD, Spoor JKH. Disciplinary law and neurosurgery: a 10-year analysis of cases in the Netherlands. Neurosurg Focus 2020; 49:E9. [PMID: 33130612 DOI: 10.3171/2020.8.focus20561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgery is historically seen as a high-risk medical specialty, with a large percentage of neurosurgeons facing complaints during their careers. The Dutch medicolegal system is characterized by a strong emphasis on informal mediation, which can be accompanied or followed by disciplinary actions. To determine if this system is associated with a low overall risk for medical litigation through disciplinary law, the authors conducted a review of disciplinary cases involving neurosurgeons in the Netherlands. METHODS The authors reviewed legal cases that had been filed against consultant neurosurgeons and neurosurgical residents under the Dutch disciplinary law for medical professions between 2009 and 2019. RESULTS A total of 1322 neurosurgical care-related cases from 2009 to 2019 were reviewed. Fifty-seven (4.3%) cases were filed against neurosurgeons (40 first-instance cases, 17 appeal cases). In total, 123 complaints were filed in the 40 first-instance cases. Most of these cases were related to spine surgery (62.5%), followed by cranial surgery (27.5%), peripheral nerve surgery (7.5%), and pediatric neurosurgery (2.5%). Complaints were filed in all stages of care but were mostly related to preoperative and intraoperative care. CONCLUSIONS The risk for medically related litigation in neurosurgery in the Netherlands through disciplinary law is low but not negligible. Although the absolute number of cases is low, spinal neurosurgery was found to be a risk factor for complaints. The relatively high number of cases that involved the sharing of information suggests that specific improvements-focusing on communication-can be made in order to lower the risk for future litigation.
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Affiliation(s)
- Wouter J Dronkers
- 1Department of Neurosurgery, Amsterdam University Medical Center, Location AMC, Amsterdam
| | | | - Dennis R Buis
- 1Department of Neurosurgery, Amsterdam University Medical Center, Location AMC, Amsterdam
| | - Marike L D Broekman
- 3Department of Neurosurgery, Haaglanden Medical Center, The Hague.,4Department of Neurosurgery, Leiden University Medical Center, Leiden.,5Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jochem K H Spoor
- 6Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands; and
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Onisoyonivosekume D, Mahrouseh N, Varga O. Introduction to Health Law. Stud Health Technol Inform 2020; 274:10-18. [PMID: 32990661 DOI: 10.3233/shti200660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In early February of 2020, attention was drawn to the increased number of deaths and the new cases of coronavirus infection. The epicentre of the outbreak was Wuhan in the People's Republic of China. In order to control the outbreak, Chinese leaders called on the city authorities in Wuhan to set up mass quarantine centres for infected people. The Chinese government took this step to protect the public against infectious disease. This is an example of the conflicts between public health and civil liberties/individual rights. Government authority is the pillar of the public health law. The government retains the power to achieve and maintain common good by restricting - within solid international and national limits - individual rights concerning autonomy, privacy, association, and liberty. Public health agencies have the right to collect, use, and disclose a considerable amount of personal health information and to enforce certain vaccinations, medical examinations, and treatments. In addition to the power to isolate individuals to protect the public against the spread of infectious disease, their powers can be used to control businesses and professions. There are several legal interventions to prevent injury and disease and promote the public's health. Among these tools are taxing policies, which encourage engaging in beneficial behaviour (fruit consumption) and disincentives to engage in high-risk activities (smoking).
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Abstract
The relevance of the European Union (EU) for health has been widely recognised within the health community for some time, and is increasingly apparent to European policy-makers and publics. Despite being an area of policy that national governments would prefer to keep exclusive control of, and though in the past it has rarely been at the top of the agenda, many elements of health have been gradually 'Europeanised'. This special issue marks the culmination of a British Academy-funded project - EU Health Law and Policy: Shaping a Future Research Agenda - which sought to build on the growing web of expertise in this field and reflect upon the future of health as an EU competence, at a time when it appeared to be under threat.
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Cooper D, Trowse P. Have Indian Surrogates Been Harmed by Commercial Surrogacy Transactions? J Law Med 2020; 27:914-927. [PMID: 32880409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Draft legislation has been approved by the Union Cabinet in India seeking to limit surrogacy to altruistic arrangements with intended parents who are either Indian citizens or couples residing outside the country but of Indian origin. This follows longstanding debates as to whether commercial surrogacy should be permitted. The primary argument against such arrangements has been the potential to exploit and cause harm to surrogate women. There is considerable literature on the exploitation debate, but little has been written about whether these transactions cause harm to surrogate women. Our article addresses this gap in the literature and develops a three-step framework using Mill's harm principle through which to assess whether harm has occurred. We apply this framework to a sample of women who provided surrogacy services in India between 2006 and 2015, the period just before the government moved to ban overseas couples from accessing commercial surrogacy.
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Patel L, Elliott A, Storlie E, Kethireddy R, Goodman K, Dickey W. Ethical and Legal Challenges During the COVID-19 Pandemic: Are We Thinking About Rural Hospitals? J Rural Health 2020; 37:175-178. [PMID: 32282953 PMCID: PMC7262323 DOI: 10.1111/jrh.12447] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Amy Elliott
- Allina Faribault Hospital and Clinic, Faribault, Minnesota
| | - Erik Storlie
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Rajesh Kethireddy
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Kim Goodman
- Clinical Ethics and Value Program, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - William Dickey
- Interim Vice President, Medical Affairs, Abbott Northwestern Hospital, Minneapolis, Minnesota
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35
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Drabiak K. The Nuffield Council's green light for genome editing human embryos defies fundamental human rights law. Bioethics 2020; 34:223-227. [PMID: 31943263 DOI: 10.1111/bioe.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 11/01/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
In July 2018, the Nuffield Council on Bioethics released the report Genome editing and human reproduction: Social and ethical issues, concluding that human germline modification of human embryos for implantation is not 'morally unacceptable in itself' and could be ethically permissible in certain circumstances once the risks of adverse outcomes have been assessed and the procedure appears 'reasonably safe'. The Nuffield Council set forth two main principles governing anticipated uses and envisions applications that may include health enhancements as a public health measure. This essay provides a critique of three aspects in the Nuffield Council's Report: its presumption of therapeutic efficacy, its inflation of parental rights to create a certain type of child, and its reliance on a specially commissioned report that appears to distort key definitions in international law.
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Affiliation(s)
- Katherine Drabiak
- College of Public Health and College of Medicine, University of South Florida, Tampa, Florida
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36
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Al-Azri NH. Providing Legal Education for Medical Students in Arab Gulf Cooperation Council Countries. J Med Educ Curric Dev 2020; 7:2382120520928386. [PMID: 33447660 PMCID: PMC7780326 DOI: 10.1177/2382120520928386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/27/2020] [Indexed: 06/12/2023]
Abstract
Law and medicine share an interest in the human body in terms of justice, well-being, and the preservation of physical integrity. Despite the long-lasting relationship between medicine and law, the tension between the two disciplines remains an unresolved issue; each requires the other, and almost all societies require them both. Therefore, there is a need to bring these two disciplines closer to render them more beneficial for society. This article addresses the need to introduce a medical law curriculum in medical schools, specifically in the Arab Gulf Cooperation Council (GCC) countries. This article first illustrates the relationship between law and medicine by defining the discipline of medical law. Thereafter, it makes a case for including a medical law curriculum in medical school and health care education programs in GCC countries, illustrating the benefits of doing so for society, individuals, and the development of the disciplines themselves. Subsequently, this article proposes an outline for a spiral and integrated medical law curriculum based on the needs and values of GCC countries. This outline is centered around the basic and advanced core topics and encourages engagement with law-medicine activities that further bridge the conceptual gap between medicine and law. This article reasserts the need to bring medicine and law closer together for the benefit of society and the development of the disciplines. One crucial way of doing so is providing formal and structured legal education for medical students.
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Affiliation(s)
- Nasser Hammad Al-Azri
- Nasser Hammad Al-Azri, Emergency Department, Ibri Hospital, Ministry of Health, P.O. Box 134, Akhdar, PC 516, Oman.
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Tilse C, Wilson J, White B, Willmott L, Lawson D, Dunn J, Aitken JF, Pearce A, Ferguson M. Community Knowledge of Law on End-of-life Decision-making: An Australian Telephone Survey. J Law Med 2019; 27:399-414. [PMID: 32129044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The law has a clear role to play in supporting patients and their substitute decision-makers (SDMs) to be involved in end-of-life (EOL) decision-making. Although existing literature suggests that knowledge of EOL law is variable among health professionals, there is little information about the extent and sources of such knowledge within the general community. A telephone survey of a representative sample of adults in three Australian States used six case scenarios to examine the extent to which adults know their legal duties, rights and powers as patients or SDMs; the sources from which people derive relevant legal knowledge; experiences of EOL decision-making; and individual characteristics associated with levels of knowledge. The results show considerable variation in levels of legal knowledge dependent primarily of the area of decision-making presented, some sizeable gaps in people's knowledge of EOL law, and varied awareness of how to access appropriate information on this subject. This study points to the need to increase community legal literacy around EOL decision-making, enhance awareness of the role of law in these circumstances and promote the availability of reliable and accessible information on the law at the time when it is needed.
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Affiliation(s)
- Cheryl Tilse
- Honorary Associate Professor, School of Nursing, Midwifery and Social Work, University of Queensland; chief investigator of a four-year interdisciplinary research project entitled "Enhancing Community Knowledge and Engagement with the Law at End-of-life"
| | - Jill Wilson
- Professor of Social Work, School of Nursing, Midwifery and Social Work, University of Queensland; chief investigator of the "Enhancing Community Knowledge and Engagement with the Law at End-of-life" research project
| | - Ben White
- Professor of Law based at the Australian Centre for Health Law Research in the Faculty of Law at the Queensland University of Technology; chief investigator of the "Enhancing Community Knowledge and Engagement with the Law at End-of-life" research project
| | - Lindy Willmott
- Professor of Law based at the Australian Centre for Health Law Research in the Faculty of Law at the Queensland University of Technology; chief investigator of the "Enhancing Community Knowledge and Engagement with the Law at End-of-life" research project
| | - Deborah Lawson
- Legal Policy Officer at Cancer Council Victoria at the time of data collection and analysis; partner investigator of the "Enhancing Community Knowledge and Engagement with the Law at End-of-life" research project
| | - Jeffrey Dunn
- Professor and Research Program Director, University of Southern Queensland; Chief Executive Officer of the Queensland Cancer Council at the time of data collection and analysis; partner investigator of the "Enhancing Community Knowledge and Engagement with the Law at End-of-life" research project
| | - Joanne F Aitken
- Professor of Public Health and the Research Manager of Queensland Cancer Council
| | - Angela Pearce
- Quality and Evaluation Manager at the New South Wales Cancer Council, Australia at the time of data collection and analysis; partner investigator of the "Enhancing Community Knowledge and Engagement with the Law at End-of-life" research project
| | - Michele Ferguson
- Senior Research Assistant, Australian Centre for Health Law Research, Queensland University of Technology, at the time of data collection
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38
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Garon-Sayegh P. Analysis of medical malpractice claims to improve quality of care: Cautionary remarks. J Eval Clin Pract 2019; 25:744-750. [PMID: 31069900 DOI: 10.1111/jep.13178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 01/05/2023]
Abstract
Medical malpractice claims can be analysed to gain insights aimed at improving quality of care. However, using medical malpractice claims in medical research raises epistemological and methodological concerns related to certain features of the litigation process. Medical research should therefore approach medical malpractice claims with caution. Taking one recent study as a an example, this article insists on three areas of concern: (a) the quantity of legal materials available for analysis; (b) the content of the legal materials available for analysis; and (c) the ways in which the content of the legal materials should be analysed and the types of inferences that it can support. The article concludes with general recommendations for future medical research that would incorporate medical malpractice claims. These recommendations centre around recognizing the qualitative dimension of legal reasoning.
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Riordan L, Warsame R, Jenkins S, Lackore K, Pacyna JE, Antiel RM, Beebe T, Liebow M, Thorsteinsdottir B, Wynia M, Goold SD, DeCamp M, Danis M, Tilburt J. US Physicians' Reactions To ACA Implementation, 2012-17. Health Aff (Millwood) 2019; 38:1530-1536. [PMID: 31479366 DOI: 10.1377/hlthaff.2019.00224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Physicians play a key role in implementing health policy, and US physicians were split in their opinions about the Affordable Care Act (ACA) soon after its implementation began. We readministered elements of a prior survey of US physicians to a similar sample to understand how US physicians' opinions of the ACA may have changed over a crucial five-year implementation period (2012-17), and we compared responses across both surveys. Of the 1,200 physicians to whom we sent a survey in the summer of 2017, 489 responded (a response rate of 41 percent). A majority of respondents (60 percent) believed that the ACA had improved access to care and insurance, yet many (43 percent) felt that it had reduced the affordability of coverage. More physicians agreed in 2017 than in 2012 that the ACA "would turn United States health care in the right direction" (53 percent versus 42 percent), despite reporting perceived worsening in several practice conditions over the same time period. After we adjusted for specialty, political party affiliation, practice setting type, perceived social responsibility, age, and sex, we found that only political party affiliation was a significant predictor of support for the ACA in the 2017 results.
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Affiliation(s)
- Lindsay Riordan
- Lindsay Riordan is a medical student in the Mayo Clinic Alix School of Medicine, in Rochester, Minnesota
| | - Rahma Warsame
- Rahma Warsame is a consultant in the Division of Hematology, Mayo Clinic Minnesota, in Rochester
| | - Sarah Jenkins
- Sarah Jenkins is a statistician in the Division of Biomedical Statistics and Informatics, Mayo Clinic Minnesota
| | - Kandace Lackore
- Kandace Lackore is a statistician in the Division of Biomedical Statistics and Informatics, Mayo Clinic Minnesota
| | - Joel E Pacyna
- Joel E. Pacyna is a analyst in the Biomedical Ethics Research Program, Mayo Clinic Minnesota
| | - Ryan M Antiel
- Ryan M. Antiel is a fellow in the Division of General Surgery, Mayo Clinic Minnesota
| | - Timothy Beebe
- Timothy Beebe is a professor of health policy and management at the University of Minnesota, in Minneapolis
| | - Mark Liebow
- Mark Liebow is a consultant in the Division of General Internal Medicine, Mayo Clinic Minnesota
| | - Bjorg Thorsteinsdottir
- Bjorg Thorsteinsdottir is a consultant in the Division of Community Internal Medicine, Mayo Clinic Minnesota
| | - Matthew Wynia
- Matthew Wynia is director of the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, in Aurora
| | - Susan Dorr Goold
- Susan Dorr Goold is a professor of internal medicine and a professor of health management and policy at the University of Michigan, in Ann Arbor
| | - Matthew DeCamp
- Matthew DeCamp is an associate professor in the Center for Bioethics and Humanities and Division of General Internal Medicine, Anschutz Medical Campus, University of Colorado
| | - Marion Danis
- Marion Danis is head of the Section on Ethics and Health Policy, Department of Bioethics, Clinical Center, National Institutes of Health, in Bethesda, Maryland
| | - Jon Tilburt
- Jon Tilburt ( ) is a consultant in the Division of General Internal Medicine and the Division of Health Care Policy and Research, Mayo Clinic Minnesota
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40
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Henein M, Ells C. Towards a Patient-Centred Regulation of Gamete Donation in Canada. J Obstet Gynaecol Can 2019; 41:1338-1340. [PMID: 31345737 DOI: 10.1016/j.jogc.2019.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/18/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
Commercial gamete donation in Canada is prohibited by the Assisted Human Reproduction Act. However, the Act permits gamete recipients to reimburse donors for donation-related expenses. Until recently, the types of expenses that were eligible and the process for reimbursing donors were not specified. In 2016, Health Canada announced its intent to develop regulations that would regulate gamete donor reimbursement; it released the proposed policy in 2017. As a result of consultations with Canadian lawmakers, physicians, and patients, debates surrounding commercial gamete donation are being revisited. Considering the ethical implications of gamete donation payment arrangements, a patient-centred care framework is useful going forward in the regulation of this practice. Patient-centred values of communication, respecting relational autonomy, and respecting patient interests should guide decisions regarding regulation of gamete donation arrangements in Canada.
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Affiliation(s)
- Mary Henein
- Biomedical Ethics Unit, McGill University, Montréal, QC; Department of Family Medicine, McGill University, Montréal, QC.
| | - Carolyn Ells
- Biomedical Ethics Unit, McGill University, Montréal, QC; Department of Family Medicine, McGill University, Montréal, QC; Department of Medicine, McGill University, Montréal, QC
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Abstract
In providing care for adolescents, maintaining confidentiality should be considered a human right and an evidence-based component of quality care. Unfortunately, complexities in the U.S. legal and health care systems have created a setting in which confidential care is inaccessible to many adolescent patients. Federal laws provide a minimum standard for confidentiality protections, but variations in state legislation relating to minor consent, special health care services, and confidentiality exemptions create large variability in adolescent confidentiality rights across the country. In certain contexts, such as consensual sexual activity, legal provisions may not align with professional ethical standards in adolescent care. In addition, contemporary clinical and administrative issues related to the electronic health record and health care financing also threaten to breach confidentiality. Although further research is necessary, providers and institutions are already well positioned to broaden protections by implementing best practices in training and education, workflow, and medical records related to adolescent confidentiality.
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Affiliation(s)
- Priya R Pathak
- Harvard T.H. Chan School of Public Health, Boston, MA.,University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adriana Chou
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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42
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Treleaven T, Tuch BE. Australian Public Attitudes on Gene Editing of the Human Embryo. J Law Med 2018; 26:204-207. [PMID: 30302982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Technology is now available which facilitates gene editing and has recently been applied internationally to embryos in the laboratory. A 2002 law in Australia prohibits making heritable changes in embryos, regardless of whether the treated embryo is discarded thereafter. We sought to begin to understand public opinion in Australia about this matter, using a questionnaire given to the audience attending a Q and A panel of experts. We found majority support for allowing heritable changes for health purposes. If this is confirmed in a larger survey of the population, we suggest the existing law should be reviewed.
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Affiliation(s)
- Tamara Treleaven
- Part-time Manager of the NSW Stem Cell Network and a PhD student at The University of Sydney, Australia
| | - Bernard E Tuch
- Director of the NSW Stem Cell Network and an Honorary Professor, Faculty of Medicine and Health, School of Medical Sciences, Discipline of Physiology, The University of Sydney, Australia
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43
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Freckelton I. Health Law: The Past and the Future. J Law Med 2018; 25:869-893. [PMID: 29978672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In the first 25 years of the Journal of Law and Medicine issues relating to abortion, euthanasia, turning off of life support, pandemics, cloning, surrogacy, technological change, patenting of DNA, regulation of health practitioners, health services in the Information and Genomic eras, mental health law, elder law, and medical negligence have figured prominently in the published scholarly contributions. This editorial reflects on the evolution of health law in its many aspects, contrasting issues that were contentious in 1993 with those that are in 2018 and reflecting on what is likely to continue to attract interdisciplinary analysis and the need for critical evaluation in the decades ahead.
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Affiliation(s)
- Ian Freckelton
- Barrister, Crockett Chambers, Melbourne, Australia
- Professorial Fellow in Law and Psychiatry, University of Melbourne, Australia
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Abstract
This essay argues that it matters for the fate of health policies challenged in court whether courts consider health merely as a policy goal that must be subordinate to law, or as a legal norm warranting legal weight and consideration. Applying population-based legal analysis, this article demonstrates that courts have traditionally treated health as a legal norm. However, this norm appears to have weakened in recent years, a trend evident in the Supreme Court's first two decisions concerning the Affordable Care Act, NFIB v. Sebelius and Burwell v. Hobby Lobby However, in its more recent Affordable Care Act decision, King v. Burwell, the health legal norm is once again evident. Whether the Court will continue to treat health as a legal norm will prove critical to the deference and weight it grants health policies in the future.
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45
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Gatter R. (Population) Health Law in Theory. J Health Polit Policy Law 2016; 41:1119-1136. [PMID: 27531943 DOI: 10.1215/03616878-3665958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This essay explores the viability of using the population health legal norm developed by Professor Wendy Parmet in her book Populations, Public Health, and the Law as a basis for theorizing health law. Based on the application of five criteria, the essay concludes that a population health legal norm has potential as a framework for theorizing health law, especially in comparison to other proposed health law theories. Yet, its potential turns on the ability of theorists to provide a detailed account of individual rights under a population health framework.
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46
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Jenkins RC, Boelens BW, Aasheim KL, Gravenstein N. No-fault compensation for ventilator-dependent children: a reasonable settlement value for lifetime attendant care. Risk Manag Healthc Policy 2016; 9:193-9. [PMID: 27574476 PMCID: PMC4990389 DOI: 10.2147/rmhp.s108238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Severe neurological outcomes sustained in childhood often result in lifetime health care needs that are beyond the financial means of most families. When severe neurological deficits are alleged to have resulted from professional negligence, relief may be sought through litigation; however, the American tort system often yields inconsistent results or no compensation for patients. We sought to identify a reasonable, objective, and data-based monetary range for a no-fault compensation system with high- and low-financial limits for those with severe neurological deficits. Based on documented life expectancies and attendant care cost studies, the data analysis indicates a no-fault settlement payment ranging from US$479,712.24 to $3,098,504.16, reasonably ensures care and services for life.
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Affiliation(s)
- Randall C Jenkins
- University of Florida Self-Insurance Program; University of Florida Healthcare Education Insurance Company; Department of Health Services Research, Management & Policy, College of Public Health and Health Professions
| | | | | | - Nikolaus Gravenstein
- Department of Anesthesiology; Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
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Padula WV, Heru S, Campbell JD. Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis. J Gen Intern Med 2016; 31:394-401. [PMID: 26481647 PMCID: PMC4803686 DOI: 10.1007/s11606-015-3529-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/16/2015] [Accepted: 09/24/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. OBJECTIVE To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. DESIGN Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3% (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). PATIENTS U.S. transgender population starting before transitional therapy. INTERVENTIONS No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. MAIN MEASURES Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost. KEY RESULTS Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000-22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints--HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85% of simulations. CONCLUSIONS Health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. Organizations such as the GIC should consider these results when examining policies regarding coverage exclusions.
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Affiliation(s)
- William V Padula
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Shiona Heru
- Commonwealth of Massachusetts Group Insurance Commission (GIC), Boston, MA, USA
| | - Jonathan D Campbell
- Center for Pharmaceutical Outcomes Research (CePOR), Department of Clinical Pharmacy, University of Colorado, Aurora, CO, USA
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Howse G, Dwyer J. Legally invisible: stewardship for Aboriginal and Torres Strait Islander health. Aust N Z J Public Health 2016; 40 Suppl 1:S14-20. [PMID: 25903648 PMCID: PMC5034501 DOI: 10.1111/1753-6405.12358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/01/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The need to improve access to good health care for Aboriginal and Torres Strait Islander people has been the subject of policy debate for decades, but progress is hampered by complex policy and administrative arrangements and lack of clarity about the responsibilities of governments. This study aimed to identify the current legal basis of those responsibilities and define options available to Australian governments to enact enduring responsibility for Aboriginal health care. METHODS This study used a framework for public health law research and conducted a mapping study to examine the current legal underpinnings for stewardship and governance for Aboriginal health and health care. More than 200 pieces of health legislation were analysed in the context of the common and statutory law and health policy goals. RESULTS Very little specific recognition of the needs of Aboriginal people was found, and nothing that creates responsibility for stewardship and governance. The continuing absence of a legislative framework to address and protect Aboriginal health can be traced back to the founding doctrine of terra nullius (unoccupied land). CONCLUSIONS We considered the results applying both a human rights perspective and the perspective of therapeutic jurisprudence. We suggest that national law for health stewardship would provide a strong foundation for progress, and should itself be based on recognition of Australia's First Peoples in the Australian Constitution, as is currently proposed.
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Affiliation(s)
| | - Judith Dwyer
- Department of Health Care ManagementSouth Australia
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Abstract
Public health's reliance on law to define and carry out public activities makes it impossible to define a set of ethical principles unique to public health. Public health ethics must be encompassed within--and consistent with--a broader set of principles that define the power and limits of governmental institutions. These include human rights, health law, and even medical ethics. The human right to health requires governments not only to respect individual human rights and personal freedoms, but also, importantly, to protect people from harm from external sources and third parties, and to fulfill the health needs of the population. Even if human rights are the natural language for public health, not all public health professionals are comfortable with the language of human rights. Some argue that individual human rights--such as autonomy and privacy--unfairly limit the permissible means to achieve the goal of health protection. We argue that public health should welcome and promote the human rights framework. In almost every instance, this will make public health more effective in the long run, because the goals of public health and human rights are the same: to promote human flourishing.
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50
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Degeling C, Johnson J, Kerridge I, Wilson A, Ward M, Stewart C, Gilbert G. Implementing a One Health approach to emerging infectious disease: reflections on the socio-political, ethical and legal dimensions. BMC Public Health 2015; 15:1307. [PMID: 26715066 PMCID: PMC4696140 DOI: 10.1186/s12889-015-2617-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/16/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND 'One Health' represents a call for health researchers and practitioners at the human, animal and environmental interfaces to work together to mitigate the risks of emerging and re-emerging infectious diseases (EIDs). A One Health approach emphasizing inter-disciplinary co-operation is increasingly seen as necessary for effective EID control and prevention. There are, however, socio-political, ethical and legal challenges, which must be met by such a One Health approach. DISCUSSION Based on the philosophical review and critical analysis of scholarship around the theory and practice of One Health it is clear that EID events are not simply about pathogens jumping species barriers; they are comprised of complex and contingent sets of relations that involve socioeconomic and socio-political drivers and consequences with the latter extending beyond the impact of the disease. Therefore, the effectiveness of policies based on One Health depends on their implementation and alignment with or modification of public values. Despite its strong motivating rationale, implementing a One Health approach in an integrated and considered manner can be challenging, especially in the face of a perceived crisis. The effective control and prevention of EIDs therefore requires: (i) social science research to improve understanding of how EID threats and responses play out; (ii) the development of an analytic framework that catalogues case experiences with EIDs, reflects their dynamic nature and promotes inter-sectoral collaboration and knowledge synthesis; (iii) genuine public engagement processes that promote transparency, education and capture people's preferences; (iv) a set of practical principles and values that integrate ethics into decision-making procedures, against which policies and public health responses can be assessed; (v) integration of the analytic framework and the statement of principles and values outlined above; and (vi) a focus on genuine reform rather than rhetoric.
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Affiliation(s)
- Chris Degeling
- Centre for Values, Ethics and the Law in Medicine, K25 Level 1, Medical Foundation Building, University of Sydney, Sydney, NSW, 2006, Australia.
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.
| | - Jane Johnson
- Centre for Values, Ethics and the Law in Medicine, K25 Level 1, Medical Foundation Building, University of Sydney, Sydney, NSW, 2006, Australia.
- Faculty of Veterinary Medicine, University of Sydney, Sydney, Australia.
| | - Ian Kerridge
- Centre for Values, Ethics and the Law in Medicine, K25 Level 1, Medical Foundation Building, University of Sydney, Sydney, NSW, 2006, Australia.
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia.
| | - Michael Ward
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.
- Faculty of Veterinary Medicine, University of Sydney, Sydney, Australia.
| | | | - Gwendolyn Gilbert
- Centre for Values, Ethics and the Law in Medicine, K25 Level 1, Medical Foundation Building, University of Sydney, Sydney, NSW, 2006, Australia.
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.
- Centre for Infectious Disease and Microbiology - Public Health, Westmead Hospital, Sydney, Australia.
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